title: Gender-related safety and efficacy of cardiac resynchronization therapy.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) is an established therapy for patients with chronic heart failure (CHF) and a broad QRS complex. Gender-related safety and efficacy data are necessary for informed patient decision-making for female patients with CHF. The aim of the study was to assess the effects of gender on the outcome of CRT in highly symptomatic heart failure patients.
  
  
  OBJECTIVE
  Gender may have an effect on the outcome of heart failure patients undergoing cardiac resynchronisation therapy.
  
  
  METHODS
  The study analyzed the 2-year follow-up of 393 New York Heart Association (NYHA) class III/IV patients with a class I CRT indication enrolled in the Management of Atrial Fibrillation Suppression in AF-HF Comorbidity Therapy (MASCOT) study.
  
  
  RESULTS
  In female patients (n = 82), compared with male patients (n = 311), CHF was more often due to dilated cardiomyopathy (74% vs 44%, respectively; P < 0.0001). Females also had a more impaired quality-of-life score and a smaller left ventricular end-diastolic diameter (LVEDD). Women were less likely than men to have received a CRT defibrillator (35% vs 61%, respectively; P < 0.0001). After 2 years, the devices had delivered more biventricular pacing in women than in men (96% ± 13% vs 94% ± 13%, respectively; P < 0.0004). Women had a greater reduction in LVEDD than did men (-8.2 mm ± 11.1 mm vs -1.1 mm ± 22.1 mm, respectively; P < 0.02). Both genders improved similarly in NYHA functional class. Women reported greater improvement than men in quality-of-life score (-21.1 ± 26.5 vs -16.2 ± 22.1, respectively; P < 0.0001). After adjustment for cardiovascular history, women had lower all-cause mortality (P = 0.0007), less cardiac death (P = 0.04), and fewer hospitalizations for worsening heart failure (P = 0.01).
  
  
  CONCLUSIONS
  Females exhibited a better response to CRT than did males. Because females have such impressive benefits from CRT, improved screening and advocacy for CRT implantation in women should be considered.
authors.affiliation: Medical Clinic, Friedrich-Ebert Hospital, Neumünster, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuchert
authors.forename: Carmine
authors.initials: C
authors.lastname: Muto
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Maounis
authors.forename: Robert
authors.initials: R
authors.lastname: Frank
authors.forename: Rita Omega
authors.initials: RO
authors.lastname: Ella
authors.forename: Alexander
authors.initials: A
authors.lastname: Polauck
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D002908:Chronic Disease; D005060:Europe; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016037:Single-Blind Method; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left